Amanda BenDor, MPH

May 9, 2018

Innovations in Global Health: Highlighting PATH’s Global Health Security work in the Democratic

Republic of the Congo

PATH/Gabe Bienczycki

PATH is a leader in global health innovation

We harness ourentrepreneurial insight, scientific and public health

expertise, and passion for health equity . . .

. . . to save the lives of

women and children.

About PATH

150MILLION

70+

2,000+

Average number of people reached by PATH and our partners per year since 2011

Countries wherePATH works

PATH partners around the world—including 60+ corporate partners

Vaccines Drugs Diagnostics DevicesSystem & service

innovations

Meningitis A vaccine: 235 million Africans immunized

Partners: Serum Institute of India Pvt. Ltd., World Health Organization

Semisynthetic artemisinin: 51 million antimalarial treatments shipped to 23 African countries

Partner: Sanofi

New test to help stamp out neglected tropical diseases

Partner: Standard Diagnostics/Alere

275,000+ doses of a new form of injectable contraceptive delivered in Africa

Partners: Pfizer, BD

30 million+ Kenyans reached with services for HIV, malaria, maternal health, safe childbirth

Partners: Government of Kenya, US Agency for International Development

What is Global Health Security?

Photos: Amanda BenDor

The Global Health Security Partnership helps countries strengthen their health systems by expanding infectious disease surveillance, strengthening laboratory capacity, and developing effective information systems to prevent, detect, and respond to infectious diseases and other public health threats.

Global Health Security Partnership

• PATH has country programs and offices in Senegal, Tanzania, Vietnam, India, and the Democratic Republic of the Congo.

• PATH works alongside each country’s ministry of health, as well as other ministries, in partnership with CDC and local organizations.

PreventImproved surveillance to rapidly detect and report threats, monitor trends, and produce actionable data.

DetectStrong laboratories with rapid, high-quality diagnostics and integrated reporting.

RespondIntegrated data information systems and visualization for prompt alerts, systemwide information flow, and informed decision-making.

All activities sustained via HQ and Country Office in collaboration with CDC and other GHS organizations.

Global Health Security overview

DRC—Setting up the country’s national Emergency Operations Center; now operational to support cholera outbreak response; official launch in May 2018. Pursuing drone/geospatial mapping activities.

India—Linking patients seeking tuberculosis care in the private sector to effective, high-quality treatment in the public sector.

Senegal—Strengthening surveillance and laboratory systems across all levels of the health system.

Tanzania—Strengthening electronic integrated disease surveillance and response. Also implementing project to improve water, sanitation, and hygiene in health care facilities to combat spread of microbial disease.

Vietnam—Developing, implementing, and evaluating surveillance systems; improving infection, prevention, and control in health care facilities.

The Democratic Republic of the Congo overview

• Population of +77 million

• Fourth most populous country in Africa

• The second-largest land mass in Africa

• Wealth of natural resources including copper, cobalt, gold, tin, diamonds, petroleum, hydroelectric power, and arable land

• Around 250 languages and dialects are spoken in the DRC; French is the official language; national languages are Lingala, Kikongo, Swahili, and Tshiluba

DRC land mass when laid over Europe

DRC context

Political• War from 1997 to 2006 caused “excessive deaths” of

3–5 million• Conflict remains, displacing millionsHealth statistics• Maternal mortality rate: 730 per 100,000 live births • Under-five mortality rate: 105 per 1,000 live births• Total fertility rate: 6.6 children• Second-highest malaria cases in the worldHealth system• 70% of Congolese have little or no access to health care• Catholic Church health system provides 40% of facility-

based care in the DRC• Health information is transforming from paper to digital—

slowly• Significant reforms are underway at political and health

system level, including decentralization

• Manage large HIV/AIDS program in Haut-Katanga and Lualaba regions, supporting over 150 health facilities

• Support elimination of human African sleeping sickness

• Second a Digital Health Advisor to the Minister of Health to advise the national strategy for eHealth

• Support the operationalization of the new national Emergency Operations Center to coordinate and support emergency response for epidemic outbreaks

• Lead evaluation of Global Fund

• Assist maternal and child health and family planning programs

• Aid response to cholera outbreak

PATH’s work in the DRC

Photo: Jessica Ilunga

Rapid response to 2017 Ebola outbreak

• May 17, 2017—An Ebola case was confirmed in

Likati health district, a difficult-to-reach area near

the Central African Republic border.

• Within days, a helicopter with supplies and the

first five responders was flown into the area by

WHO/MSF. PATH supported MOH by linking

geospatial mapping resources of the area to

responders and providing MSR Community

Chlorine Makers, portable devices that produce

chlorine for disinfection with minimal inputs.Photo: World Health Organization/S. Hawkey

• PATH worked with partners to accelerate the launch of a new Emergency Operations Center in order to

coordinate the response in public health emergencies such as this Ebola outbreak.

• July 2, 2017—WHO declared end of the outbreak.

Innovative partnerships in the DRC

• Rapid deployment of DigitalGlobe satellites to update imagery over Likati health zone during Ebola outbreak

• Imagery provided to Humanitarian OpenStreetMap Team for feature extraction (roads/settlements)

• Updated maps and layers provided to MOH, WHO, MSF, and other responders

• Exploring a collaboration with WeRobotics to set up and deliver training courses on unmanned aerial vehicles (drones) in the DRC

• Collaborating on GRID project—mapping health facilities and population (MSH, UCSL, Gavi, BMGF, Global Fund)

DRC Emergency Operations Center

• EOC will ensure that data are collected in real time, as well as connecting data from various sources (the national laboratory, DHIS2, EPI, and acute flaccid paralysis surveillance)

• EOC will be hub for data collected in real time, as well as connecting data points from various sources (laboratory, district, routine immunization, and acute flaccid paralysis surveillance)

• PATH support:• Provided MOH guidance with how to establish an EOC that will be functional and sustainable

in the context of the DRC; coordinated a visit of DRC MOH and EOC staff to Senegal EOC to learn from their experience

• Supporting procurement of equipment for physical space

• Hiring staff—Surveillance Manager and Communication Manager

• Training staff on emergency response and data use

Supporting outbreak of cholera

• While we were setting up EOC, the cholera outbreak worsened—spreading into regions not endemic to cholera, such as Kinshasa.

• EOC was used to coordinate the response.

• PATH deployed 40 MSR Community Chlorine Makers, which produce chlorine using water and salt in 5 minutes for use in the field.

• Steve Davis, PATH CEO, and Linda Venczel, GHSA Director, visited the DRC in December to deliver chlorine makers.

Photo: PATH/Dr. Leon Kapenga

Joint external evaluation

• A multisectoral external assessment of country-level health security capacity, covering 19 technical areas

• Recommendations presented in March; next, the International Health Regulations (IHR) National Focal Point will develop a multisectoral plan with a road map to strengthen the implementation of the IHR in the DRC

• Several priority recommendations:• Develop or adapt legislative or official documents for better implementation of the IHR 2005 under the “one

health” approach.

• Strengthen the multisectoral framework for coordination, cooperation, and collaboration for the prevention, preparedness, detection, response, and recovery of the all-hazards approach.

• Draft, update, and apply the required procedures in all technical fields to standardize and harmonize interventions in the emergency management cycle.

• Establish and implement operational plans for acquiring the minimum capabilities required under the IHR 2005, with particular emphasis on the adequate and ongoing training of staff in all key sectors, especially at the lower-level national health pyramid to cover the entire country.

“One of the biggest lessons is

that Congo needs to be

digitized to have better

surveillance systems and faster

emergency response. Congo’s

inability to communicate with

itself is a potential risk to the

world.” —Trad Hatton, PATH

DRC Country DirectorPhoto: PATH/Lynn Heinisch

Harnessing digital systems: PATH brings more people onto digital platforms and promotes digital innovations that improve health equity

PATH vision:

Digital health mission:

Guiding principles:

PATH envisions a world where innovation ensures that health is within reach for everyone.

Ensure digital innovations improve health.

We will …

Put the user first.

Collaborate for impact.

Focus on sustainability.

Uphold country ownership.

Evaluate and evolve solutions.

What does digital health mean?Ruth and her daughter,

Esther, live in a village

with no electricity or

health facilities.

The nearest

clinic is one

hour’s walk

away.

Ruth must take

time off

working her

family’s farm

to bring Esther

to the clinic for

her routine

immunizations.

Ruth owns a

simple mobile

phone.

For Ruth and Esther digital health means ...

→ Ruth is alerted via SMS when it’s timefor Esther’s immunizations.

→ Vaccines and immunization supplies areavailable for Esther when they travel tothe clinic.

→ If Ruth moves villages and goes toanother clinic, Esther’s immunizationrecords won’t get lost.

Better data systems result inbetter patient services.

Creating a data-led culture

Digital health building blocks as levers for change

Copyright © 2016, PATH, Vital Wave. All rights reserved.

EXTERNAL TRENDS

WHAT IT MEANS FOR

GLOBAL

DIGITALHEALTHSECTOR

Global trends driving and impacting the global digital health sector

Source: https://blog.path.org/2017/12/navigating-digital-transformation/

A snapshot of PATH’s digital health work

• BID Initiative: Scaled electronic immunization registries in Tanzania and Zambia, improving immunization data quality and use.

• Data Use Partnership: Supporting the Ministry of Health to develop and implement a Digital Health Investment Road Map over the next 5 years.

• Digital Square: Coinvestment model to accelerate scalable solutions to strengthen national digital health systems and the African Alliance for Digital Health Networks.

• Joint Learning Network for Universal Health Coverage (partnership with WIPRO): Facilitating a learning network of 10 countries and, with those countries, codevelop guidance for IT systems supporting universal health coverage.

• Visualize No Malaria (partnership with the Tableau Foundation): Using data analytics to drive malaria elimination in Zambia.

Digital health GHSA highlights

Support eIDSR system in Tanzania’s Arusha andKilimanjaro regions:

• Capacity-building to regional and district focal points, including data use skills building

• Coordinate with national and subnational government onimplementation of DHIS2 for eIDSR

• Collaborate with partners to facilitate interoperability of lab and surveillance data

Work alongside MOH in Senegal to improve surveillance and laboratory systems:

• Leading training for all hospitals to use DHIS2 for surveillance

• Providing ongoing support to facilities, including laboratories, to improve surveillance systems

• Implementing a digital lab mapping assessment to identify gaps in national laboratories

Photo: Amanda BenDor

Thank you!

Amanda BenDor, MPH

Technical Program Manager

PATH

Twitter: @AmandaBenDor

Email: abendor@path.org